Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2014) 35 P1023 | DOI: 10.1530/endoabs.35.P1023

ECE2014 Poster Presentations Thyroid (non-cancer) (125 abstracts)

Is Clinical Activity Score (CAS) a sufficient indicator of the response to therapy with i.v. methylprednisolone (MP) and external radiotherapy (RT) for Graves orbitopathy?

Iwona Palyga 1 , Aldona Kowalska 1 , Janusz Mysliwiec 2 , Grazyna Gajos 3 , Robert Palyga 4 & Danuta Gasior-Perczak 1


1Department of Endocrinology Holycross Cancer Centre, Kielce, Poland; 2Nuclear Medicine Department Medical Univestity in Bialystok, Bialystok, Poland; 3Outpatient Ophthalmology Clinic, Kielce, Poland; 4Department of Radiology Holycross Cancer Centre, Kielce, Poland.

Introduction: Treatment of Graves orbitopathy (GO) is one of the most difficult problems in clinical endocrinology.

Objective: To establish the efficacy of the regime used in the treatment of GO and to analyze methods used to determine treatment effectiveness.

Material: The study involved 30 patients with moderate to severe GO (according to the classification of EUGOGO) being in the active phase of GO.

Method: Patients were treated with weekly infusions of MP (6×500 mg+6×250 mg), and with RT (1 Gy/day–for 10 days in weeks 7 and 8). Before and after treatment each patient underwent clinical examination with clinical activity score (CAS), ophthalmologist examiation with determining exophtalmos (Hertel), MRI examination of retrobulbal region determining the number of muscles involved, their thickness, activity and radiological degree of exophthalmos. The severity of diplopia has been determined subjectively by the patients. Results were compared in groups: responders (RESP) and non-responders (NON-RESP).

Results: We found:

i) a reduction (normalization) in CAS in all patients (mean reduction rate of 2.5 points in RESP, and of 2.4 in NON-RESP).

ii) Statistically significant reduction in the severity of diplopia, exophthalmos (Hertel and MR), number and thickness of involved muscles in RESP group compared to no statistically significant reduction in these parameters in NON-RESP group.

iii) Inflammatory activity in extraocular muscles has normalized in all patients from the RESP group (normalization of T2 time signal in MRI), in contrast to the lack of normalization in the NON-RESP group.

Conclusions: i) In our opinion, the normalization of CAS does not always indicate a sufficient clinical response to treatment with above regime (MP+RT).

ii) If measured only by CAS the treatment regime reaches 100% efficacy. After joining the results of ophthalmological examination, MRI, and subjective assessment of the diplopia, the efficacy decreases to 80%.

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